MDs ignoring less invasive alternative to hysterectomy

Two years after the FDA approved a minimally invasive treatment for uterine fibroids, hundreds of thousands of women are still being subjected to needless hysterectomies and are not being informed about possible alternative treatments.

According to the Society of Interventional Radiology (SIR), uterine fibroids are the most frequent reason for hysterectomy in pre-menopausal women and result in one-third of the 600,000 hysterectomies performed annually in the United States.

Up to 40% of women age 35 and older have non-cancerous uterine fibroids, which cause heavy bleeding, as well as pain in the back, legs, pelvis, and during intercourse. A widely available minimally invasive procedure, known as Uterine Fibroid Embolization (UFE), often replaces the need for hysterectomy surgery, but remains widely underutilized

UFE is performed by an interventional radiologist who makes a tiny nick in the skin, less than one-fourth of an inch, in the groin and inserts a catheter into the femoral artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor, causing it to shrink and disruptive symptoms to subside.

The particles are FDA approved for UFE, based on comparative studies showing UFE to offer similar efficacy with less serious complications compared to surgery. UFE is effective for multiple fibroids, and offers less risk, less pain and less recovery time than hysterectomy — as well as preserves the uterus. On average, 90% of women who have the procedure experience significant or total relief of heavy bleeding and other symptoms.

For years, the medical profession has been criticized for performing too many unnecessary hysterectomies. A report in Obstetrics & Gynecology concluded that 70% of the hysterectomies performed in the U.S. are recommended inappropriately.

Another research report, published in the Journal of Reproductive Medicine, found that the risk of death in women undergoing hysterectomy is 12 for every 10,000 procedures performed. Yet, despite the risk, more than half of women who underwent hysterectomy subsequently developed symptoms that they believed were caused or worsened by the procedure, according to a report in the British Journal of Obstetrics and Gynaecology.

SOURCES: “Hysterectomy Rates Unchanged in Spite of Widely Available Treatment,” Society of Interventional Radiology, Aug. 24, 2004. 

“The appropriateness of recommendations for hysterectomy,” by Broder MS, Kanouse DE, Mittman BS, Bernstein SJ, Obstetrics & Gynecology 2000 Feb;95(2):199-205.

“Self-reported long-term outcomes of hysterectomy.” Schofield MJ; Bennett A; Redman S; Walters WA; Sanson-Fisher RW, British Journal of Obstetrics and Gynaecology, 98(11):1129-36 1991 Nov.

“Hysterectomy. A critical review,” by Bachmann GA, Journal of Reproductive Medicine 1990; Sep;35(9):839-62.